Sunday, December 27, 2009

Apologies for Lack of Posting

I haven't given up but I am in a place where I don't have much opportunity to use the internet. I will be back at work in early January and should have ample opportunity then. I wish readers a good holiday.


Monday, December 14, 2009

Aids Denialism Doesn't Make the Disease Go Away

There are many controversies surrounding HIV, development in general and various other things. So, writing a blog about these can attract some controversial remarks, in theory. In practice, I have received some comments but few that are controversial. When remarks have little or nothing to do with what I have posted, I delete them. If the post is clearly just an attempt to attract attention to some site, product, issue, service or person, I am also likely to delete them.

But a comment I received today, anonymous of course, purported to be about my most recent posting, which discusses levels of HIV transmission from unsafe medical practices. 'Anonymous' may have thought that in questioning certain aspects of HIV funding and the like, I am aligning myself with certain Aids sceptics, who deny that HIV causes Aids, or whatever. Whether this anonymous contributor represents or not is irrelevant; I do not agree with what the site stands for and I would not wish to have anything to do with a group of people whose only aim seems to be to further muddy these already turbid waters.

My approach to HIV in Kenya has been that of a general scientist. My interest is in the overall conditions in Kenya and how they changed as HIV arrived, spread and continues to spread. Therefore, I look at history, economics, social practices, lifestyles and many other things, in addition to medical and social science aspects of the virus. I do not have the scientific expertise to address all the details of the AliveandWell site. There are plenty of people who can do that, if they deem the content of the site worth the effort.

As for the idea that HIV and Aids were 'invented' by some wealthy people so they could make money (or even take over the world), I have never heard anything that could make such a hypothesis the least bit plausible. No doubt the AliveandWell site is teeming with such evidence, but I think I have more worthwhile things to spend my time on.

Some of the numerous 'experts' cited on the site may well have a great deal of expertise, I really can't say. Certainly, some of them seem to have lots of letters after their name. But people can make up qualifications, or pay for them. And plenty of well qualified people come out with utter rubbish that can be used by whoever wishes to shore up some rant that they like to call 'theory' or 'hypothesis'.

The anonymous poster says AliveandWell advocates 'scepticism' around HIV but the site is the work of a group of Aids denialists who encourage the use of 'alternative therapies' for HIV positive people. HIV positive people would be well advised to consider the fate of the woman who started the site, Christine Maggiore, who died of Aids, along with her infant daughter. Maggiore refused antiretroviral treatment for herself and for her daughter.

To adopt the stance that Maggiore and her followers recommend is not scepticism, it is idiocy. Some adults may wish to adopt such a stance, which is regrettable. But there is no justification for imposing such idiocy on people who are unable to defend themselves. There is enough disinformation about HIV/Aids in developing countries already without this sort of deception being peddled and I hope people who visit AliveandWell see the site for what it is.

Those are my thoughts on your wonderings, Anonymous.


Saturday, December 12, 2009

Don't Have Sex and Don't Go to the Hospital

Over the past twenty years or so, there have been a few papers pointing out that HIV transmission through unsafe medical practices, especially in Sub Saharan African countries, may be higher than previously thought. These papers don't seem to have had much impact and when modes of HIV transmission surveys have analyzed the part that such practices might have played in the current HIV pandemic, they have usually reported that heterosexual transmission is the most common, followed by things like male to male sex, intravenous drug use, commercial sex work, etc.

The possibility of unsafe medical practices playing a large part in HIV transmission is being raised again, though it is hotly disputed by some. But given the amount of guesswork involved in estimating HIV prevalence in high prevalence countries, it would not be surprising if the figures were open to question. If it were established that HIV was regularly transmitted through medical practices, it would certainly dent the widely held belief that HIV can be fought purely by trying to control people's sexual behaviour.

I and some others have long opposed the view that sexual behaviour alone can adequately explain the massive rates of HIV transmission in certain countries, compared to the relatively small rates in other countries. This is not to deny that sexual behaviour is an important factor in HIV transmission, just to question the idea that certain people in certain African countries have more sex or have more partners or whatever, than people in other countries around the world.

But unsafe medical practices would be unsurprising in a country that spends so little on health, a country that has so few properly trained medical personnel, so few hospitals, a country where the vast majority of people can't afford to go to a health professional when they are ill and who may often be better advised not to go at all.

The cries of those who claim that massive funding for HIV treatment and care is justified may be well founded, I don't know. But one thing is for sure: in the time that HIV treatment has been well funded, hospitals and clinics have not improved noticeably, rather, they have disimproved. Staff numbers have fallen. Disease rates have risen. All the indicators suggest that the disimprovements in health that started in the 1980s, before Aids had had much impact, have continued right up to the present, high Aids funding levels notwithstanding.

So, as the anti circumcision lobby might say, this is not a good time to start mass male circumcision programmes. There may never be a good time, the case for mass male circumcision is still unconvincing, but no one in their right mind would opt for an operation on their penis or the penis of their child or relative until health services have been improved. People need to be confident that they will get better in hospital, not worse. Children in Swaziland whose mothers are HIV negative and who had attended hospitals and clinics a lot were found to be most likely to be HIV positive. Similar studies have been carried out in other African countries.

Whether you are going to a clinic or hospital for HIV related services or anything else, you are in danger of suffering from unsafe medical practices. The health service in Kenya is on its knees. Expensive HIV treatment or circumcision programmes either need to have their own infrastructure built from the ground up, which seems highly inefficient, or they have to wait until health services are built up in their entirety.

Kenyan's are still waiting for their health service to be rebuilt. The circumcision programmes have stalled, thankfully, some would say. And the HIV treatment campaigns are seriously hampered by the condition of the country's health services. Indeed, antiretroviral treatment is probably also hampered by the low levels of health in the population, but who is going to notice that? There just aren't enough health professionals to bear witness to the chaos that exists.

The whole issue is a reminder of how little is known about the true nature of different HIV epidemics in different countries. Many of the figures that are used to shape the various approaches to the disease are pure guesswork and interpretations are often strongly shaped by influences that have little to do with science or even reason, for example politics, religions and 'morality'.

A sensible conclusion to draw from warnings about the safety of medical procedures would be to spend more money on health infrastructure and especially on training more health personnel. More money is probably need for HIV specifically, but it will be money thrown down the drain until health infrastructure has been improved.


Thursday, December 10, 2009

The One Trick Pony That Can't Defy Gravity

When debates become polarized there can be a danger that neither side can accurately characterize the view of their opponent. Thus, Gregg Gonsalves of the International Treatment Preparedness Coalition characterizes a particular view as the 'Aids backlash' and lumps together a number of views that may not even be held by any particular person or group. He characterizes the backlash thus:

The belief that "the fight against AIDS has misdirected our energies towards broader goals in health and development; the provision of antiretroviral therapy is a folly, it's too expensive and isn't worth the money to continue its expansion; efforts against AIDS are destroying health systems and promoting unnecessary deaths from other simpler-to-treat diseases and conditions such as childhood diarrhea".

Personally I think there is probably not enough money put into the fight against Aids and that much of that money is not being used very well. In particular, I think too little of the money is being spent on prevention and almost all of that is not being used very well. True, it took some time for the international community to face the threat that Aids presented but when they did face it, they came up with a level of funding that has never been matched by campaigns against other diseases or disease groups (such as sexually transmitted infections, water borne diseases, etc).

I don't think the provision of antiretroviral therapy (ART) is a folly and I don't think people who hold the sort of sceptical view I've expressed in the last paragraph necessarily do either. The fact that there are many more people becoming infected than there are being put on ART is not an argument to reduce ART programmes, rather, it is an argument for finding out why HIV prevention is being ignored and rectifying this situation urgently. There is little point in spending nothing on people until they become infected with an incurable illness if something could be done to prevent them from becoming infected.

But also, there is little point in treating people for HIV and leaving them to die of something else. There are many preventable and treatable diseases that are killing people, including people who are HIV positive. I think that this is, in part, because of poor health facilities and services and an acute shortage of personnel. But also, there is a lack of funding that goes back several decades.

I am in complete agreement with Gonsalves when he points out that poor health services are not a result of the Aids pandemic. This is clearly true in Kenya and many other developing countries, where poor health services date back to the early 1980s, when Aids existed but hadn't been identified and certainly hadn't even begun to wreak the havoc that came later. Aids didn't help these ailing health services and certainly decimated the health workforce, as well as the workforce as a whole. But in short, Aids was just another nail in the coffin for public services in general, not just health.

I sympathize with Gonsalves to some extent, but when is money going to be spent on HIV prevention programmes that work, as opposed to programmes that promote purely political (including religious and pseudo-religious) ends? When is money going to be spent on the things that concern the most people, the many diseases and social problems that most people face? I needn't list the diseases or even the problems, Gonsalves would be more aware of them than most.

Some of the people that Gonsalves may gloss over as the 'Aids backlash' wonder how HIV positive people will benefit from a one trick pony health programme that can give them ART but nothing much else, perhaps not even the food they need to be able to take the antiretroviral drugs. They wonder why HIV positive people with certain diseases are more worthy of treatment than those who are dying of the very same easily preventable and treatable diseases. They wonder why those who are at risk of becoming infected with HIV are not entitled to very much, but if they become infected, they may receive a great deal.

But, more importantly, I think: what kind of HIV programmes can be implemented successfully in countries that have inadequate health services, along with poor standards of education, hardly any social services, very little infrastructure, lack of political leadership, governance, legal systems and levels of equality that would be required for these very expensive programmes to work? Even one trick ponies can't work without any solid foundation, as the Aids one trick pony amply demonstrates.


Friday, December 4, 2009

Foundations for HIV Prevention

I rarely come across articles criticizing HIV prevention programmes for their lack of success, but apparently a contributor to the Social Aspects of HIV/AIDS Research Alliance conference this year draws attention to the fact that many 'prevention' interventions were implemented without ever being tried. He may have gone on to say that ones that were tried and found to be useless continue to attract most prevention funding, but I wasn't at the conference.

Professor Geoff Setswe is right that HIV took some time to be recognised and had already infected many people before the most appropriate methods of preventing its spread had been investigated. But more than 25 years later, prevention programmes continue to be rolled out that are untested or that are tested but found to have little or no benefit. But no one is counting bodies when there is money to be made.

It's easy to blame health and other social problems on the global economic crisis now, but that wasn't the problem just over a year ago. In Kenya, since the 1980s, one excuse after another has been blamed on the lack of progress in education, health and other areas. If it wasn't economic, it was oil or food or political or environmental and if it wasn't a crisis it was a disaster. The HIV pandemic itself is just one of those many 'disasters' or 'crises'.

But poor health in Kenya is not a disaster, nor is it a short term crisis. Health services have been reduced in Kenya at least since the early 1980s, when the Moi government depended on loans from international financial institutions to prop up his form of democracy. These institutions funded him in return for his agreement to cut spending on social services and the public sector in general. It seems unlikely he or his colleagues (who overlap considerably with the present administration) were particularly worried about the idea of reducing public spending.

Health service spending in Kenya is now minimal (as are spending on education and other social services). Health infrastructure needs to be built from the ground up, more or less. Most people don't go to hospitals or clinics and many who do fare worse than they would have if they had stayed at home. It's little wonder that HIV was transmitted rapidly in Kenya during the 1980s and continues to spread today, despite the hundreds of millions of dollars spent on the disease. There are still far more people being newly infected than receiving treatment, though a lot more money is spent on treatment.

Fine, Professor Setswe, clinical trials are not always appropriate for testing social and behavioural interventions. But are clinical trials needed to show that starving people need food, that those suffering from malnutrition need proper nourishment, that poor people need support, that sick people, whatever they are suffering from, need medical attention, that those without adequate supplies of water die of thirst or water borne diseases? And the list goes on. Those who pigheadedly continue to talk about how difficult HIV is to prevent seem to be uninterested in what those in high HIV prevalence countries really suffer from.

HIV is a real disease. Those suffering from it need treatment and care. Those who are in danger of becoming infected need to be protected from it or to be enabled to protect themselves from it. But most people will get up in the morning and have food, water, work, school fees, day to day health and many other things on their minds. And in all the time that HIV has been around, these other concerns have been largely deprived of attention and funding.

Finally, mass male circumcision is mentioned as a possible HIV prevention method that is supported by a lot of evidence but has been held up for various reasons. Perhaps one of the reasons that circumcision has been held up is because health services in Kenya and other countries who were tricked by those same international financial institutions have been reduced to the extent that it is not possible to roll out any kind of mass health programme. Some of the HIV programmes that were rolled out failed because infrastructure, education, health and many other areas have been so underfunded for so long.

The same article mentions a Dr Ntanganira, who says that "We know what works". But the article doesn't say what works, unfortunately.


Tuesday, December 1, 2009

The Aids Industry Sure Knows How to Blow its Own Trumpet

Yesterday was World Aids Day again and in Kenya you couldn't miss the copious amounts of advertising, bunting, leafleting, t-shirts, sun visors and other paraphernalia of the industry. High and not so high officials were out in strength to collect their per diem, without which, presumably, nothing important could happen. There were the mobile testing clinics in areas that already have static testing clinics and millions and millions of condoms distributed.

For all it's faults, the Aids industry has published some figures that certainly look good. Botswana, which has one of the worst HIV epidemics in the world, has the highest percentage in any African country of people on antiretroviral therapy (ART), the highest rates of HIV testing and the highest number of women on ART to prevent mother to child transmission (PMTCT). They also have the third highest percentage of children on ART.

Over several decades, the campaigns to recognise the rights of HIV positive people to receive treatment have been successful in a lot of countries. In many developing countries, a sizable percentage of HIV positive people in need of treatment are on treatment. In the West, very few babies born to HIV positive mothers are themselves HIV positive. Indeed, the percentage of HIV positive babies born to HIV positive mothers is declining in a number of developing countries too and should be relatively low by now in a country like Botswana, where such a high percentage of HIV positive mothers are receiving PMTCT.

But rights seem to be most commonly recognised for those who are already infected with HIV. If you read various developing country HIV strategic plans (which are curiously similar, despite the epidemics being very different in quality), you will notice that the word 'rights' is rarely used except in relation to HIV positive people, mainly in relation to access to treatment. The rights of those who are not yet HIV positive, and that's most people, are rarely mentioned. Yet they have a right to the things that will ensure that they remain HIV negative.

Of course, it is hard to quantify the effects of the various HIV prevention programmes that have been rolled out in Kenya and other African countryies. Most of them were run by wealthy organisations who could afford the 'research' and publicity that would make them look very successful. The reality is that very little is known about preventing HIV and, beneath the hype, few programmes have been truly successful.

I would be the first one to admit that the very idea of cutting HIV transmission is fraught with difficulties. Many things have been tried, some of them perhaps even well thought out. But in the end, there is very little money to be made out of prevention and therefore very little money put into it. Condom distribution is an exception, but where there is little or no health or science education, let alone sexual and reproductive health education, condoms haven't really taken off that well. You may have heard otherwise but there are good commercial reasons for that.

The problem with the majority of the prevention programmes that have received some of the relatively small amount of money that is available for HIV prevention is abstinence. Most programmes relied on the idea that if people would just abstain from sex, they would not be likely to be infected. The more liberal advocated abstinence until marriage, until it was noticed that more and more people are becoming infected by their spouse. But various programmes were cobbled together that, one way or another, advocated abstinence or what amounts to abstinence. People didn't abstain and most of them won't. This is not something peculiar about developing countries. Abstinence campaigns have failed where ever they have been tried.

The reason I mention the rights of people who are HIV negative is that many of them will, sooner or later, become infected with HIV because one or several of their rights are presently being denied. People, whether adults, children, male or female, have a right to health and a right to treatment when they are sick. Yet more people in Kenya and other developing countries are dying of easily treatable and curable diseases than are dying of Aids.

Children have a right to a decent education and part of that should include levels of health and science education that should give them the prerequisites to attain enough understanding of sex, sexuality and reproductive health to avoid becoming infected with HIV or other sexually transmitted diseases and to avoid unplanned pregnancies. In a word, people need education to lead healthy lives.

People have a right to a decent standard of living for themselves and their children, they have a right to adequate food and nutrition, they have a right to good standards of governance and security, water, sanitation, infrastructure and many other things. They have a right to a legal system that protects them from harm and persecution and the like. Women need to be given the same rights as men, in the workplace, in the economy, in education, in health and everywhere else. Men who have sex with men, intravenous drug users and commercial sex workers need their rights protected.

It is the denial of the sorts of rights mentioned above, along with various other rights, that leaves people vulnerable to becoming infected with HIV and suffering many other serious consequences. People in developing countries who are suffering from HIV now, and those who have died of it, were likely denied one or several of their rights. HIV is not transmitted in isolation from people's circumstances, from the conditions in which they live and work.

Those who are HIV positive and those who are HIV negative are equally entitled to their rights, though skewed funding for Aids would suggest that this is not the case. In order to avoid transmitting HIV to others and in order to remain HIV negative, everybody's rights need to be protected. In short, everyone is entitled to these rights and without them, the treatment and care programmes for people who are HIV positive will be, to a large extent, in vain; the half hearted prevention efforts will also be in vain.

Prevention has proved to be a slippery fish. But treatment and care for one disease in isolation from all the other things people can and do suffer from has also been less successful than it should have been. There is little point in treating one incurable disease and ignoring the many others that are more easily treatable and often even curable. But that is what's happening. The Aids industry is just too rich and powerful to allow people to know that.


Monday, November 30, 2009

'Religiosity' and Levels of Social Capital

The work continues with Ribbon of Hope Self Help Group, Nakuru, in Kenya's Rift Valley. We have ongoing projects producing basic foods such as vegetables and staples, dairy cattle and hens, etc. And we are still hoping to spread the word about ways of saving money by using solar cookers and home made fuel briquettes for cooking and various other techniques. Any project that costs very little or nothing will be considered as long as it is appropriate for people in this area and as long as it is sustainable and not destructive or damaging in any way.

As usual, some people are cooperative and hard working, otherwise, there would be no point in an organisation such as Ribbon of Hope. But sometimes it seems as if there are as many obstructive people as there are constructive people and it can be hard not to dwell on them. Especially when they so often win out and destroy projects that would have worked well without their interference. Today, we had the experience of trying to find out why some people abandoned their basic accounting and record keeping several months ago and now seem both unable and unwilling to say how they have been running their organisation.

It would be unreasonable to expect everyone to be equally successful in their endeavours and it is natural for some people to get involved initially, only to step back later and contribute less than before. But, much though I'd like to think that there are more cooperative than destructive people here, the evidence suggests that this is not true. I'm sure there are all sorts of possible explanations and I would be the first to admit that the people we work with live under all sorts of stresses and pressures that can make them a bit desperate. But I'm not going to make excuses for some of the things I've seen and heard about. I'll just hope that in the long run there are more positives than negatives and that Ribbon of Hope manages to attract serious contributors rather than time and resource wasting people.

There is a very interesting 'index' called The Legatum Prosperity Index, which aims to look at prosperity beyond the one dimensional Gross Domestic Product (GDP) favoured by so many economic analyses. The index looks at various economic figures, politics and governance, education, health, security, personal freedom and social capital. The whole index seems skewed by what are almost exclusively Western values but it's still an interesting exercise and their report is well worth the read.

Kenya doesn't come out very well, scoring 95 overall out of 104 countries for which there was adequate data available. This is not to say that Kenya's data is particularly reliable but let's give it the benefit of the doubt. The country receives a pretty low score for almost all the various indexes and rankings available. Economically, the country is weak in many ways and is particularly dependent on raw materials. Education, health, governance, personal freedom and security rankings are very poor. Surprisingly, the country is said to have well developed democratic institutions.

But the real shocker for me is that the country is ranked 25th for its level of social capital; 'most Kenyans find others to be reliable and some actively volunteer or help strangers'. Sadly, some people who 'volunteer' only do so for what they can get out of it. Apparently Kenya's social capital score is 'boosted by exceptionally high levels of religiosity'. Well, that's certainly no surprise. But many of the people who profess the loudest to be Christian, Saved, Born Again or whatever else are the ones who never miss an opportunity to get something by deceit.

I think this element of the Prosperity Index begs the question about whether high levels of religiosity is an indication that Kenya is strong on social capital. The police and other officials who require a standard bribe in order to do what is just their job are often as ostentatiously religious as anyone else. An official who tried to get a 50 dollar bribe out of me asked me to pray for him when he found I wasn't going to pay. The people who dress up for church on Sundays overlap with the mob that crowded around a young homeless boy to beat him for some offence, real or imagined. This sort of mob rule, usually aimed at very vulnerable people, such as elderly people branded as 'witches' or homeless people branded as thieves, is very common. Some of the 'volunteers' I have met never miss an opportunity to mention their love for Jesus but nor do they miss an opportunity to get something that is intended for sick and dying people.

This is not an attempt to bash the 'religious' people of Kenya or of any other country, just a question about what kind of connection there is between 'high levels of religiosity' and high levels of social capital. Reluctant as I am to come to this conclusion, I would say that social capital is one of the things that Kenya is most sorely lacking in. And this lack of social capital has had, and continues to have, a profound influence on high levels of HIV, sexually transmitted infections (STI), unplanned pregnancies, stigma, discrimination and probably many other problems.


Sunday, November 29, 2009

Superweeds: What Doesn't Kill Them Makes Them Stronger

One of the big promises of the industry that produces genetically engineered (GE) crops is that they will allow farmers to use less pesticide, thereby saving money and reducing negative impacts on the environment. But a recent paper shows that these claims don't stand up to scrutiny. On the contrary, pesticide use has increased almost every year in the thirteen years that GE crops have been planted on a large scale in the US.

Crops such as cotton, corn and soybean are genetically engineered in order to withstand a particular type of pesticide. That pesticide is sprayed over a large area and kills everything but the crop. That's the theory, anyhow. So the industry has spent a lot of money trying to rubbish the claims that eventually weeds would evolve that would be resistant to the glyphosate herbicide that needs to be used in increasing amounts on GE crops; these have been dubbed 'superweeds'. But such weeds have evolved and they keep evolving to resist higher levels of glyphosate and anything else farmers try to do to keep them under control.

This glyphosate is a pollutant that degrades land and contaminates water. Its serious effects on the environment, on conventional agriculture and on animals, domestic and wild, have been demonstrated many times but they have also been shown to cause health problems in humans. Reproductive, birth and neurological problems have been linked with exposure to pesticides.

Those using GE crops are not permitted to collect seeds to plant the following year and are compelled to buy seeds every year from the GE industry, in addition to the pesticides and the increasing amounts of herbicide. But farmers who try to buy conventional corn, soybean and cotton seeds find that there are few stocks available. Almost all these important crops have been taken over or contaminated by GE versions in the US.

And this industry wants us to believe that GE crops are the future for developing countries? Producers of GE crops in the US now have to spend so much money controlling resistant weeds that it is eating into their profits. Coupled with the costs of pesticides, it won't be long before there will be no profit at all. And the industry's claims about the increased yields from GE crops have never been demonstrated either. Yields are affected by resistant weed infestations, of course, but the yields have been no better than those of conventional crops. Sometimes they have been a lot lower.

In developing countries, where conditions are far from ideal, the chances of farmers even getting normal yields from GE crops are slim. And as the costs go up farmers will be unable to continue and will be forced to try to return to conventional crops. But their land and the land of those around them will, by then, be contaminated, as will seed crops. Their land, and even land close by that never bought into GE crops, will continue to produce weeds that are resistant to pesticides and the crops will be contaminated with GE strains for many years, if not decades.

It's ironic that this supposedly great technological achievement has now resulted in US farmers having to employ people to pull up weeds by hand. But this will not be an option for people in developing countries. They will not be able to withstand the pressures of increasing costs along with falling yields and GE crops will be a disaster for them, even more so than it is for industrialised countries. Monsanto and Syngenta are the main offenders mentioned in this report, names that will be familiar to those who have followed the GE industry to date. Their plan is to produce more pesticide and to produce stronger versions. That should help a lot.


Friday, November 27, 2009

Self Destructiveness Seems Like a Strange Quality in a Church

I've had time to read UNAIDS's 2009 HIV Epidemic Update and it's interesting, but perplexing in many ways. Take, for example, the issue of unprotected sex with multiple partners. As a result of research into different modes of transmission and their relative importance in different countries, it was found that Kenya has a particular problem with people having unprotected sex with several different partners.

This didn't come as a big shock, of course. Many people, all over the world, have unprotected sex with several different partners. But the risk of transmitting or being infected with HIV is much higher in a country with high prevalence of HIV and certain other sexually transmitted infections (STI). And Kenya is such a country, with 7-8% HIV prevalence, high prevalence of STIs known to make one more susceptible to transmitting and contracting HIV (such as herpes simplex virus), very poor education and health services and an attitude towards condom use that is, I suspect, strongly influenced by conservative religion and politics.

The shocking thing is how many people are willing to take such risks with their sexual partners while refusing to use condoms, coupled with the fact that tens if not hundreds of millions of dollars have been spent on HIV prevention campaigns that advocate the use of condoms. A recent campaign by the extremely wealthy, powerful and conservative Population Services International (PSI) aims at stopping relationships on the side or multiple relationships. The campaign mentions condoms too but concentrates on stopping the relationships.

The trouble is that after many years of some parties campaigning for safer sex, others have been campaigning for no sex at all or no sex except inside marriage. The volume of this sort of campaigning is high and usually advocates against the use of condoms or suggests condom use only in difficult circumstances (such as where one's partner is already infected with HIV). Aside from the fact that in Kenya, Uganda and other countries, the chances of becoming infected by one's marital partner is higher than becoming infected by a casual partner, many people are not married, are no longer married or have not, as yet, been able to get married. So lecturing them about abstaining till marriage can be a rather pointless exercise.

One of the apparent results of all these campaigns that have a pseudo-moral political and religious agenda is that people have internalised the message about not using condoms but they haven't given up having sex with a number of different people. Many of the people who engage in multiple partnerships are married, so they are in danger of infecting their partner or being infected by their partner. And yet the religious and political zealots keep ranting on about condoms and how they are not the solution.

The Catholic pope is quite right when he says that HIV cannot be overcome by relying exclusively or primarily on the distribution of condoms. They need to be used, all the time, and properly in order to reduce the transmission of HIV. He may also be right about the importance of conjugal fidelity, but conjugal fidelity appears to be rather rare, perhaps more so among those married in the Catholic church than in many others. As for sexual abstinence, it appears to be rare in the Catholic church and is not even a foregone conclusion among those who profess to have taken a vow of chastity.

If we lived in the sort of world the pope is talking about, where everyone did only what they were supposed to do with regard to sexual behaviour, there would be no need for condoms or many of the other things that he and his ilk object to so strongly. But then, nor would there be HIV or other sexually transmitted infections. Maybe people shouldn't have sex except within marriage and for the purpose of procreation, according to some moral code. But people have sex, defecate, eat, drink, sleep and play.

According to the moral code of some people, having sex or exercising many other forms of human behaviour are not, in themselves, moral or immoral. Which is not to say it is not wrong to have sex with one person when you are in a relationship with someone who thinks that they are your only partner, for example. But the pope sees having sex outside the strict bounds of Catholic teaching as absolutely wrong. And using a condom to avoid an unplanned pregnancy or to protect oneself from HIV or any other STI is also wrong. Yet, in a world where people only had sex within those strict bounds, it would seem strange to even have to make a pronouncement about contraception.

Maybe the pope will keep going on about abstinence until marriage and the evils of contraception. If he does, all the worse for the Catholics who choose to listen to him. And I'm talking about the Catholics who live in this world, in Africa in particular. Because a lot of them don't seem willing to take all of his advice, preferring to select the bits they like and leaving out the bits they don't like. The pope is surprisingly influential and as a result of his influence, HIV continues to spread rapidly in Kenya and other countries. It infects innocent people, through various means, young and old people, religious and non-religious people and especially people who have sex. And that's most people, as far as I know.


Wednesday, November 25, 2009

Celebrate World Aids Day By Dismantling UNAIDS

UNAIDS has never been shy about producing long and colourful documents about HIV/Aids and in the last couple of days they have released two; the Outlook Report 2010 takes a look back and compares the HIV pandemic of today with that of the mid 1990s; the second document is the yearly AIDS Epidemic Update, which I haven't had the strength to read yet.

The Outlook Report, like many of the various articles commenting on one or other of the reports, sometimes takes a rosy view of how the international community and the AIDS community have dealt with the pandemic. In the sense that things have moved on, and finding that you are HIV positive no longer has the significance it once had, they are right. We have come a long way in treating what was once an untreatable illness that would lead to a certain and very unpleasant death.

But the worrying thing is how the Outlook Report, like many UNAIDS and other reports in the past, talk about the importance of HIV prevention. It has been obvious that HIV prevention is so important that the amount of HIV money spent on it needs to be increased considerably. But the amount has gone down and the prevention programmes that get most of the money have little or no effect and have never had much effect.

Defenders of the disproportionate amount spent on treatment and care of HIV positive people are fond of pointing out that this shouldn't be an either/or debate. True, it shouldn't, both treatment and care on the one hand and prevention on the other should receive more funding than they presently receive and the funding should be more equitably divided. Treatment and care contribute a certain amount to HIV prevention but they are not the same as prevention and they will never contribute more than a certain amount. That's why there are five new infections for every two people put on antiretroviral treatment.

The report goes on to allude to the work that has been done to show that prevention programmes, such as they are, fail to target those most at risk in populations. Most of the money is spent on populations as a whole and very little on, for example, men who have sex with men, commercial sex workers, intravenous drug users, prison populations, fishing communities around Lake Victoria, mining communities and various others, who are very often at risk because of their occupation or lifestyle.

The report seems aware that HIV transmission is not primarily about individual behaviour and that there are different kinds of HIV epidemic in different countries and that some people are more at risk than others. It even seems cognizant of the fact that it is the circumstances in which people live that makes them more or less likely to become infected with HIV. But it hasn't made the leap to realizing that in some countries, especially developing countries, most people live in such circumstances. Not everyone is at equal risk of becoming infected but most people live in conditions that mean they are already at high risk of becoming infected or that they will one day be at high risk of becoming infected.

That makes it sound like HIV prevention is unlikely to ever have much success, but the opposite is true. Treatment and care have been to a large extent dominated by commercial interests. Products, processes and services have been developed, many by those who are in a position to profit from them. But prevention has been dominated by the party-political and pseudo-moral debates of political and religious leaders. Their aim is to further their own agenda, which are far from being concerned about millions of people becoming sick and dying.

Raising awareness about HIV, sexually transmitted infections, sexual health, reproductive health and anything else is good and will go a long way towards protecting people from a number of dangers. But good overall health, healthcare, nutrition, food security, education, infrastructure and many other benefits would give people the maximum protection, not just from HIV, but from other illnesses and ills.

And this brings us to another often repeated pronouncement made by various senior HIV/Aids experts. They like to deny that HIV funding has distorted health and development funding and disrupted more general programmes that aimed to benefit societies as a whole. HIV/Aids funding is not too high, it needs to be higher. But there needs to be a similar move to spend the money more equitably. HIV will not be eradicated without health services, education and other social services, no matter how much money is thrown at it.

So, spending money on all other areas of development will also contribute to the fight against HIV/Aids. But continuing to spend disproportionate amounts on HIV/Aids will not benefit the many other development issues that have been hijacked by numerous commercial and political interests. HIV treatment and care is just one of many health issues that the world faces but HIV prevention is about health, not disease. Therefore it has far broader significance and affects far more people than one single disease. In fact, it affects everyone.

Ultimately a self-serving and very expensive organisation, UNAIDS needs to be reabsorbed back into the overall agenda of public health, or some agenda that encompasses the health of everyone, not the sickness of a few. This is not to say that HIV positive people should not be entitled to treatment or care. Rather, they and all other sick people should be entitled to treatment and care. But people who are not sick should be enabled to stay that way. UNAIDS is good at diverting a lot of money for people once they are HIV positive but this is denying the right of HIV negative people to stay that way.


Tuesday, November 24, 2009

Stop Thief, There's More!

At present, Tanzania is Africa's third largest producer of gold but may be set to become the largest. Gold mines towards the North of the country, formerly mined by Tanzanian artisanal miners, have for a long time been making a handful of foreign mining companies very rich. But recently, gold that is still being mined by Tanzanian artisanal miners in the South of the country has attracted the interest of a handful of foreign mining companies, who can expect this to make them very rich.

It's interesting how this is a 'discovery' because, as far as Tanzanian artisanal miners are concerned, they discovered the gold. It's their livelihood and not a very good one at that. But it's better than the nothing they will be left with once the big gold extractors move in. Typically, big gold miners employ a few thousand people, compared to the hundreds of thousands that will be displaced.

Time and time again, such gold 'discoveries' have been trumpeted as great news for Tanzania (or Kenya or Uganda or where ever). But Tanzanians should be well aware of how much they have profited from their vast mineral resources. Or rather, they should be aware that they have been systematically impoverished because of their vast mineral resources. Uganda has had a recent opportunity to find out how gold 'discoveries' affect ordinary people and even Kenya will have an opportunity soon, as gold has also been 'discovered' in the Kenyan Mara region.

The American company buying a large but very cheap interest in these recently 'discovered' gold deposits will be given all the usual benefits of non-existent oversight, few taxes, if any, minute royalty payments, most of which they will probably renege on, somehow, and the freedom to exploit Tanzania's rather loose employment and other human rights protections. In return, Tanzania will experience a large increase in unemployment and a loss of resources that will never be compensated for; Tanzania being, already, one of the poorest countries in the world.

Oddly enough, there is also a recent article about safety in small mines in Tanzania. This issue is not often reported on, although the issue of safety in large mines is even less reported on. Not because large mining interests have a great safety record, they just spend more on publicity. The secrecy that surrounds big mining in Tanzania and other developing countries doesn't come cheap. Only the employees do that. It's true that safety in smaller mines has been neglected by the government for a long time but that's no excuse for giving the Americans, the South Africans and the Canadians carte blanche to plunder the country's gold. I'm just assuming the appearance of these two articles at around the same time is not a coincidence.

To be fair, many mining employees earn better than average wages, though nothing to write home about. But this doesn't make up for the fact that for every one employed there could have been ten or twenty put out of a job. Nor does it excuse the mind boggling, tax free salaries that the non-Tanzanian employees get (which are usually kept secret). And it certainly doesn't make up for the fact that the country is highly dependent on foreign aid, not because it is poor, but because everything it has of value is stolen with the connivance of senior statespeople and businesspeople, Tanzanian and non-Tanzanian alike.

Critics of large scale theft of gold from developing countries recommend that donor countries, international institutions and the like champion the interests of countries such as Tanzania. Well, the World Bank, the International Monetary Fund (IMF), America, Britain, Canada and many others who could be championing the interests of development are too busy fighting for the other side. The lack of regulation in Tanzania and other developing countries mainly emanates from the so-called international institutions, whose focus always appears rather national.

And America, Britain and Canada may well be big donors. But the amount of money they give in aid donations is very small compared to the amount they pilfer. I don't think it's reasonable to expect thieves to just put their hands up, so it's up to the Tanzanian people, through their government, to fight this one out. It remains to be seen whether they will continue to hand over their future or whether they will demand a more equitable way of managing their resources. So far they have behaved like a person confronted by someone raping their wife and offering the rapist their mothers and children.


Thursday, November 19, 2009

Sex Workers Need Support, Not Condemnation

Malawi's aim to give sex workers an alternative to sex work is a step in the right direction and it's certainly better than the finger wagging and moralising that passes for policy in Kenya and other African countries. Sex workers will be offered low-interest loans to start small businesses and in return they will be expected to give up sex work.

But a serious problem with this approach on its own is that most small businesses fail. There is a limit to the proportion of a population that can depend on small businesses for their income. And if there are too many small businesses, even the ones that don't fail do badly.

Besides, it's not just sex workers and currently unemployed people that want access to microcredit, especially to set up small businesses. Many people are just about getting by, earning tiny amounts of money some of the time and turning up to work every day in the hope of earning enough to pay the next day's fare to work.

A lot of people you talk to, especially in professions such as beauty therapy and hairdressing, for example, say that their ambition is to either make or borrow enough money to set up a small business, a salon or something that is more dependable than an employer who may not even pay up the pittance that is owed.

And when people have access to credit, too many of them seem to go for the very businesses that have already flooded the market. Selling second hand clothes is something of a euphemism among sex workers because there are so many people doing it, a lot have to resort to commercial sex work to make enough to survive. Many sex workers that I have met are trained in hairdressing, beauty therapy or hotel and catering in one of the numerous colleges (or rather dubious quality) that you see in even the smallest towns.

Commercial sex workers, subsistence workers, homeless people, indeed, any poor or vulnerable people, face a number of problems. Not having enough money to survive is just one problem in what can be a long chain of circumstances. This substantial group of people is not exclusively female, but it is predominantly female.

Girls are less likely to go to school, less likely to have adequate school attendance, less likely to complete primary education, less likely to go on to or complete secondary education and in the end, they are unlikely to have enough education to compete for the small number of jobs that are open to females. Even those who do well at school are unlikely to get a job that pays a reasonable income and this is particularly true of females.

Many girls with too little education are probably poor and even if their family has some money, it is more likely to be spent on boys. So if a girl or woman decides to get some training or vocational education, finding enough money is one of the biggest problems. Commercial sex work is far better paid than any of the other options available. It would be interesting to know how many girls and women raised the money to go to hairdressing or beauty therapy school through sex work only to end up supplementing the meagre income they subsequently earn by returning to sex work.

There are two points that need to be highlighted here: firstly, older women, those in their thirties and forties, are in the most urgent need of finding alternatives to sex work. For them, sex work doesn't have the many dangers that it has for younger women. Older women have to compete with younger women by resorting to more risky sexual practices and by working for less, which means they have to find more clients. But for many older women, it's just not possible for them to get clients any more. Worse still, the sex industry is currently flooded with sex workers.

The second point is that commercial sex workers themselves need protection. No amount of grant money for small businesses is going to result in sex work disappearing off the face of the earth. On the contrary, if the process of enticing women away from sex work is successful, the price of commercial sex will increase. Unless governments can also banish poverty and unemployment, sex work will become an even more attractive option because the price it attracts will go up.

In Kenya, sex work itself is not against the law. Living on immoral earnings is against the law and some of the people who make most out of the earnings of sex workers include the police. They persecute sex workers and get a steady income from them and because police have so much power, most sex workers are too scared to be arrested or changed. They pay up, thinking that the alternative could be a lot worse.

And they are right. Sex workers face regular threats, such as beatings, arrests, rape and persecution. Although this is not always at the hands of the police, sex workers are not protected by the police or anyone else. As the aim of enticing sex workers away from commercial sex is partly to reduce the transmission of HIV, they Malawian government will also need to take measures to protect the rights of women, whether they are involved in sex work or not.

In Kenya, good education about reproductive, sexual health and even health in general are rare, especially for those who don't even receive a decent level of education of any kind. Health services, including reproductive and sexual health are under funded and effectively unavailable to most people, including those who are most in need.

Malawi and other countries with high HIV prevalence need to prioritize business training, low-interest loans and alternative sources of income for women who want to give up sex work, who are likely to be able to leave sex work and who will be able to make a better living by leaving sex work. Eradicating commercial sex completely will take a lot longer.

Those who will continue to have to resort to commercial sex work need the protection of the law, they need to be protected from the excesses of the police and other officials and they need to be protected from the many people and bodies who treat them like criminals when they are more likely to be victims of crime and corruption. If sex workers have access to social and health services and their rights are protected, this will go a long way towards reducing the spread of HIV.

Moralizing and finger wagging will continue to have little impact. The Kenyan plan to do a survey of commercial sex workers and other vulnerable people will be futile if people have no protection from the sort of prejudice and discrimination that has been whipped up by the moralizers and finger waggers. The current constitution makes no plans to provide such protection, so such changes are still a long way off.

The Malawian government is to be applauded but they and other governments need to deal with the human rights issues that are involved in commercial sex work, such as poverty, vulnerability, corruption, prejudice and extreme violence. It’s not commercial sex work per se that results in high rates of HIV transmission. It’s the living and working conditions faced by those who have to resort to commercial sex work.


Tuesday, November 17, 2009

When Water is Scarce, Develop Hydroelectric Power Installations

It hardly comes as a surprise, but electricity prices in Kenya are increasing because of unreliable rainfall patterns. Unwisely, Kenya depends to a large extent on hydroelectric power. So when there is a prolonged drought power is in short supply. Expensive, inefficient and highly polluting emergency power is generated using fossil fuels to make up some of the shortfall.

Hydroelectric dams have been built in developing countries for many decades. This may have seemed like a good idea a long time ago, although it is more likely to have appealed to the Western engineering companies and others who reaped substantial profits from the building of these installations. But the multiple disadvantages of hydroelectric power are now widely recognized, disadvantages including inefficiency, expense and irreversible environmental damage.

For the moment, I'll leave aside the (albeit important) question of who is profiting from the production of emergency power over such a long period of time, which makes it seem less of an emergency and more like plain stupidity. But the cost increases for electricity, said to be about 60% over the past six months, are being passed on to hard pressed consumers. This is particularly galling in a country where only a minority of households have an electricity supply.

Already, well over half of Kenya's power is, ostensibly, generated by hydroelectric installations. This suggests a surprising overdependence in a country that has several viable alternatives. But there are now plans to build a new dam in Coastal Province (where most of the country's hydroelectric power is produced) to provide domestic water supplies, irrigation and electricity. Tens of millions of dollars will be spent on something that is unlikely to work very well and will have serious adverse impacts. The money is coming from the Chinese government and, while water infrastructure is badly needed, another huge dam hardly seems like the best approach given the history of such projects in developing countries.

Kenya could produce enough electricity for all its citizens using sustainable and relatively cheap sources, such as wind, solar and geothermal. There are good reasons for keeping water supply and irrigation separate from electricity generation because hydroelectric power is not just inadvisable, it's also quite unnecessary in Kenya. Touting the project as being a solution to water shortages doesn't explain why such a large amount of money is being spent on it. We are not told what the Chinese government is getting in return. Oil and other natural resources, probably.


Sunday, November 15, 2009

Deciding Who Gets to Eat and Who Gets to Starve

A curious feature of some of the big famines in history is that the countries experiencing the famine were not necessarily short of food. Likely as not, the majority of people were very poor and did not have the money to buy food, but food was being produced and exported.

Many millions of people in a number of developing countries currently face food shortages, malnutrition and probably famine at a time when the world is producing record crops. The Food and Agriculture Organisation (FAO) estimates that 2008 saw the highest recorded cereal crop production figure ever. It is predicted that 2009 will see the second highest figure.

Wikipedia is a great source of information but their bald statement that "[f]amine is caused by a human overpopulation relative to the available food supply" is in need of qualification. It is estimated that as many as 10 million Kenyans face serious food shortages, but this is not clearly because the country is overpopulated. There are several other significant pressures on food production and access to food.

For example, many people are extremely poor, have always been poor and have little prospect of ever becoming less poor. Food prices have been driven up over the past few years by market speculation and by the use of productive land for growing biofuels. So poorer people, who could barely afford enough food before these trends began, are now facing starvation.

Other pressures include droughts, often followed by serious floods, which result in poor harvests and destroy large tracts of arable land. There was also widespread unrest in Kenya in 2008 and people abandoned their land. A number of these internally displaced persons (IDP; the Kenyan government is not keen on releasing figures for just how many are still displaced) now have little means to feed themselves and no chance of returning to where they came from. And the majority of people have only a tenuous hold on land, renting it from unscrupulous landlords, who can treat tenants as they wish and sell their land at the drop of a hat.

In addition to growing biofuels in Kenya, there are other trends that result in less land being used for affordable food. Land is bought up by natural resource prospectors, such as those in search of oil around Isiolo and those in search of gold in the Mara. This land will not be used to benefit any Kenyans and certainly won't be used to grow food. And much of Kenya's land is used for non food crops or for food products intended for export, such as coffee, tea, flowers, fruit and vegetables. Controversially, a lot of land comprises national parklands, preserved for use by those who can afford to visit it. Most can't.

Despite all these pressures, there is a lot of food being produced in Kenya for export and a lot of arable land available for food production. The reasons people face food shortages and poor nutrition are the same as they have always been: widespread poverty and increasing levels of impoverishment along with rising food prices that mean the poorest will lose out.

When things get really bad and people are dying of starvation, maybe other countries will start shipping in relief food, but this will not improve food security in Kenya. Food security refers to access to food, as well as its production. As with other countries that experienced famines throughout history, resilience will continue to be low, there will be widespread disease, many people will have abandoned rural areas and moved to cities; there will be no remaining seed to grow the next season's crops, no fertilizer, no chance of resisting whatever new pressures arise.

The more I read about famine, the more it seems like a process whereby the rich systematically deny food to the poor in order to increase their profits. But that couldn't be correct, could it?


Friday, November 13, 2009

Did Someone Say 'Final Solution'?

I have read various articles about the proposal to carry out a 'gay census' in Kenya. But none of them shed any light on why the Kenyan government should suddenly be interested in identifying some of those most at risk of being infected with and of transmitting HIV. The best way to make gay people feel they are not being singled out is to make HIV and sexual health services available to all, without prejudice.

In fact, the proposal is not just to single out men who have sex with men (MSM). The proposal also aims to identify commercial sex workers (CSW) and intravenous drug users (IDU). That's hardly going to make members of these groups feel any better. They all have several things in common: they are all doing something considered to be illegal. They are also the subject of prejudice, discrimination and condemnation by political and religious leaders.

Men who have sex with men, commercial sex workers and intravenous drug users need access to sexual health services. They also need access to more general health services, the protection of the law from persecution by members of the public and by the police. But programmes involving what is often referred to as 'harm reduction' are not popular in Kenya. The possibility of decriminalising sex between people of the same gender, commercial sex work or even intravenous drug use is not even being discussed right now.

So what strikes me as most suspicious about the call to carry out this gay census, or census of people who are most at risk from HIV, is that it is being funded by the President's Emergency Plan for Aids Relief (PEPFAR). PEPFAR has always been vehemently opposed to harm reduction measures, such as the use of condoms, needle exchange programmes and other activities that are known to help reduce the spread of HIV and other diseases.

Why would PEPFAR now be interested in funding this particular approach? Are we supposed to believe that the initiative has changed to such an extent that harm reduction is no longer refused funding? And are we also supposed to believe that the Kenyan government has completely reconsidered its earlier views on gay sex, commercial sex work and intravenous drug use?

I suspect the motives behind PEPFAR's decision to fund any kind of 'survey' of some of the most vulnerable people in the country. I suspect the Kenyan government's motives, too. I have heard rumours that a number of powerful people in the US are not completely unrelated to Uganda's current discussions of an effective pogrom against gay people. This is not the way to reduce HIV transmission and it will have numerous other human rights consequences.

Unless many other things are in place that guarantee the safety of people affected by this proposed 'survey', and that will include people who don't actually fall into any of the targeted groups, the whole thing should be abandoned immediately.


Thursday, November 12, 2009

Tomorrow's Disasters Are Preventable Today

I think most people, if they saw their child playing near a fire or in some other dangerous situation, would do something about it before an accident occurred. They wouldn't just watch and then shell out the money for hospital fees once an accident had occurred. But donor money is usually spent on clearing up after a disaster has hit.

Many children (and quite a number of adults) in developing countries are severely burned because most cooking is done on open fires, close to the ground. Donor money is sometimes forthcoming for the expensive surgery and skin grafts required by people who have suffered burns. But it's not often you come across substantial projects to provide people with alternatives to cooking on open fires, using mainly wood or charcoal.

Burning wood and charcoal accounts for a very large proportion of the carbon emissions from developing countries. Forests are fast disappearing and wood is getting more expensive and less viable as a fuel source. The use of wood and charcoal is part of a massive environemntal disaster. There are cheaper alternatives, such as solar cooking, biogas and the use of fuel briquettes made from combustible materials.

There is a lot to be gained from not burning wood and charcoal. There are the environmental benefits and safety benefits to consider. Also, people in close proximity to wood and charcoal cookers suffer from respiratory problems, one of the top killers in developing countries. Alternative fuels are cheaper, even free. And their use can reduce the time and effort taken to collect wood and produce charcoal.

But rather than see aid money go into proejcts that have these multiple advantages, we continue to direct it to big disasters. The children that suffer terrible burns, that we wish to see treated, shouldn't have to suffer these burns in the first place. The plastic and reconstructive surgeons should be concentrating on people who are not suffering from preventable injuries.

Similarly, money for surgeons and health resources is spent on reconstructing the faces of children affected by noma, which affects children suffering from malnutrition. Food security and proper nutrition would prevent many other illnesses and health conditions, in addition to noma, and would also reduce deaths, especially among infants and young people. Those who don't die from illnesses arising from insufficient food and nutrition still suffer stunted growth and retarded mental development. These are all avoidable.

The current debate about land grabbing in developing countries, where greedy multinationals are buying up huge tracts of land to grow food for rich countries, is an idle exercise if it does not go any way towards reducing this phenomenon substantially. By the time this land has been ravaged by industrial scale farming and contaminated by genetically modified organisms, it will be too late. What is the point knowing now what the consequences will be if we are not going to do anything about it?

Much of the land being grabbed is destined for biofuel production. The ridiculousness of starving people producing crops to fuel the cars of well fed people, far away, seems to be lost on us. We, the people benefitting from the increasing impoverishment of the poor, may be willing to see our governments giving large sums of aid money to starving people in the future, but we don't seem to want to do anything to prevent the circumstances that will eventually leave people starving.

Land grabbing, especially for biofuel production, results in food, water and other vital resources being exported from poor countries to rich countries. If we prevent the land grabbing now, we won't have to send aid money later to the disaster we are so busy creating.


Monday, November 9, 2009

Widespread Environmental Contamination and Loss of Biodiversity Are 'Externalities' to the GM Industry

The Kenyan government has been persuaded that it can 'revive' the country's cotton industry by introducing genetically modified GM cotton varieties. The first thing that springs to mind is the principle reason for the death of cotton industries in Kenya and every other developing country in the world: subsidies for American cotton farmers. It is not possible for poor countries to produce cotton at a price that can compete with the heavily subsidized American cotton, which is why most country's cotton industries failed many years ago.

Of course, these American subsidies are illegal and they are completely antithetical to the country's constant bleating about the importance of free trade. But double standards have never mattered to rich countries and they never will.

There may well be theoretical benefits to GM organisms, such as cotton, it's hard to know. The GM industry has been pumping out inaccurate and misleading data on trials for so long that they probably don't even know what is true and what isn't by now, and probably don't care much, either.

But the problems that will arise if farmers buy into the thirty pieces of GM silver are more obvious, for those who can be bothered about them. The GM producer in question, Monsanto, which has an unrivalled corporate social responsibility record, claims that farmers will save on pesticide costs because they have to spray less frequently. Unfortunately, they will be obliged to pay more for seeds, spray using expensive pesticides produced by Monsanto and the land they spray will be denuded of all species, from the microscopic up. Expensive Monsanto herbicides will do the same for any plant species.

This is a mere externality to Monsanto and probably to the Kenyan government. The fact that the land and water surrounding land planted with this cotton will be contaminated, probably irreversibly, is also an externality and those promoting the introduction of GM cotton even have the cheek (or ignorance) to claim that it will have a positive impact on the environment and the health of those working on cotton plantations.

In addition to the problem of having to buy seed every year from Monsanto, because it's not possible or even permissible to collect seed at the end of the season, it will be difficult for the farmers to get out of the grip of Monsanto, if and when they wish to. Their land and the land around will be contaminated with the GM cotton for generations and even these contaminated crops could be deemed to the be intellectual property of those generous people at Monsanto.

Many of the claims put about by GM hawkers are yet to be backed up by evidence but even they make little effort now to deny that GM crops are unlikely to be of any benefit to small farmers. The vast majority of farmers in Kenya and other developing countries are subsistence farmers who aim to grow enough food to live on and sometimes grow some cash crops to supplement their income. Although various cash crops have long been foisted on small farmers, many have felt the sting of becoming locked into producing things like tea, sisal, coffee, sugar and biofuels, for example, only to find that yields and prices never match up to what they were promised.

Small farmers who buy into GM crops need to ask themselves if they can afford to become locked into yet another non-food crop that will never be truly economical and may leave them worse off than before. Large scale farmers may not experience the same worries, but whole communities in Kenya and other countries need to consider what the potential effects of widespread contaminated land and water may be. They also need to consider the consequences of most of their food production being owned by a multinational that is not even bound by the country's laws.

It's worthwhile for Kenyans to bear in mind that cotton industries in developing countries did not decline because of pests and other problems but because a more powerful country controls the market. This is not likely to change quickly and the Americans are not going to give up the level of control that they have cheated so hard to obtain. Similar remarks apply to other GM crops. GM is not a technology for the poor, it is a technology for the powerful, like many technologies. But of course, it's of less use to the powerful unless the poor believe that they too need GM technology.


Sunday, November 8, 2009

Lack of Sanitary Pads is a Threat to the Health of Kenya as a Whole

The hype about how brilliant the introduction of 'free' primary education has been in Kenya continues six years on but the reality is that most parents who couldn't afford primary education before 2003 still can't afford it. The hidden costs are endless and include levies for parent teacher associations, uniforms and overpriced books, equipment, 'extra' tuition, etc. A colleague recently pointed out to me that parents need to pay for their child's desk every year. There must be quite a surplus of desks in schools by now.

While enrollment figures are high for state schools, they have dropped in many private schools and the figures for attendance and completion, even of primary school, are not so brilliant. Numbers of girls completing primary school and going on to secondary school are particularly poor. There are many reasons for girls not completing their education, including the belief that as girls will marry into another family, it is not economical to 'water ones neighbour's fields'.

But a study in Uganda suggests that many girls are dropping out of school as soon as they start menstruating. Schools are not equipped to deal with girls once they start menstruating, apparently. Lack of separate sanitary facilities for girls, and even lack of water, mean that they will often stay at home, either for the duration of their period or even for good.

The extremely high cost of sanitary pads mean that they are inaccessible to many girls. They have to use substitutes or stay at home. To put it in perspective, ten of the cheapest sanitary pads cost more than several days worth of the staple ground maize for a large family. The commonly advertised branded versions cost twice or three times as much and, because one or two of them are sometimes given out as promotional 'gifts', some people think they must always use this version to be really safe.

As well as having to teach sex education without talking about sex, teachers are also in the position where they are usually not trained to include classes about menstruation, either. Teaching about the whole field of sex, sexuality, reproduction, sexual health and sanitation is often considered to lead to immoral behaviour in young people. This can be blamed on taboo or cultural considerations but in fact, it often has more to do with political and religious leadership and funding sources for sex education and education as a whole.

In the end, large numbers of girls with little or no education means that large numbers of children will, in the future, also be brought up with little or no education, knowledge of sex or reproduction or even with the level of empowerment needed to change anything for the better. Continuing gender imbalances mean continuation of the status quo. That's a status quo where much of the population will never be able to attain a decent standard of living, while the more privileged continue to enjoy the great wealth that exists in Kenya (despite the best attempts of colonials, neo-colonials, multinationals and other assorted leeches).

The introduction of 'free' primary education was a little like some of the other initiatives that only aim to tackle one or two headline indicators. (In fact, any of the millennium development goals (MDG) would be additional examples.) School fees were abolished but immediately replaced with costs that mean parents still have to pay de facto fees. There are still far too few teachers and classrooms in many areas to provide decent levels of education.

When it comes to education relating to sex, reproduction, health, sanitation or anything like that, few teachers have been trained to provide these. And there is little to be gained from health and sanitation education when the health and sanitation facilities, even reliable supplies of clean water, are not available to the majority.

Successive governments, along with those who dream up international 'initiatives' don't seem to have noticed that basic needs are basic for the very reason that, without any one of them, people's standard of living is compromised. Children who have little or no food for much of the time will have retarded growth and mental development, poor health and a short life. Lack of sanitary facilities reduce health but this also reduces access to education and the efficacy of education. Basic needs are connected to each other, so you can't just make a list and tick them off as you create an 'initiative' that relates to each one.


Friday, November 6, 2009

HIV Treatment is Necessary, But Not Sufficient, For Prevention

Medicins Sans Frontieres (MSF) has published a report on reduced funding for HIV treatment, from the World Bank's Global Fund and the US Government's President's Emergency Fund for Aids Relief (PEPFAR) in particular. MSF have good reason to be worried.

The pharmaceutical industry successfully lobbied governments and international institutions to pay huge amounts of money for antiretroviral (ARV) drugs that most of the people suffering from HIV/Aids would never be able to afford. In fact, the governments of countries with high rates of HIV/Aids would never be able to afford these drugs, either.

Countries like Kenya have the option to produce generic versions of ARV drugs at a fraction of the price that is currently being paid. But most countries, including Kenya, have chosen not to exercise this right, preferring to enact laws that make it unlikely that the country can produce or even purchase such cheap generic versions. Good relations with the pharmaceutical industry seems to be more important to them than saving the lives of their citizens.

MSF are right, huge ARV rollouts cannot now be stopped without endangering the lives of millions of people who are HIV positive and even people who are, as yet, HIV negative. But rather than arguing for the money to keep coming, in fast increasing amounts, they could concentrate on finding ways of reducing the cost of treatment so that it can continue and even expand.

How much of the billions of dollars of aid money have been spent on building factories to produce drugs that people need in Kenya? I haven't heard of any. Most of the money has been spent in ways that don't go on to produce anything or increase the country's sustainability or self reliance. The funds have mostly been spent as if HIV is just an emergency.

Well, it is something of an emergency, but there are underlying factors that are not part of an emergency. The country has a decaying health service, decaying education sector and a small and decaying infrastructure. People are poor, unhealthy, badly educated and unable to access vital services, such as clean water and proper sanitation. These are the things that face the majority of Kenyans every day, whether they are HIV positive or not.

Money spent on drugs, regardless of the overall condition of health systems is, to a large extent, wasted. Many drugs go out of date before being distributed, they get to people unprepared to take them properly, they are taken by people who are dying of other, easily prevented and treated illnesses, etc. My argument is not that ARVs should not be purchased and distributed and prescribed; it is that there needs to be a proper, accessible health service for all this to happen.

There is not a proper health infrastructure in Kenya, there hasn't been for a long time and increased HIV/Aids funding has not brought about a health infrastructure that serves people's needs. True, there are many clinics and institutions that were not here before HIV/Aids and wouldn't have even appeared. But these mostly deal with HIV/Aids, not other, basic health problems that people face.

My argument is also directed at the emphasis on HIV/Aids treatment over prevention. MSF's Goemaere is right to object to the prevention/treatment 'dichotomy'. Of course treatment has a positive effect on prevention efforts. But it is not enough to try to treat our way out of the epidemic. This is clearly not working and much more needs to be done to prevent new infections. Otherwise, the aim to treat everyone who requires treatment becomes even less attainable and less sustainable that it is right now.

People who are HIV positive need more than just drugs, or even treatment. There are a lot of threats to their health and welfare than HIV. They are dying because they are too far from the hospital, because the hospital is not up to the job of caring for them, because they are entitled to benefits they don't know about or that have been stolen by someone else, because they are poor and isolated and not considered important enough. But there just aren't the services needed to support chronically sick people and these will not just appear because the country is swamped by HIV/Aids (treatment) related institutions and programmes.

Those who are HIV negative need to stay that way and this won't happen by rolling out ARVs, alone. They have needs that are far more important and urgent that the possibility that they may become infected by something that won't kill them for many years. Most won't live for very long anyway, for a huge variety of reasons that are not being addressed right now.

Goemaere recognises the false dichotomy of treatment/prevention, but fails to see that increasing treatment while effectively ignoring prevention will not combat HIV/Aids in the long run. Assuming that HIV treatment will also prevent infections is not enough because it doesn't prevent enough infections and it never will. And treatment will never be as efficient as it should be if health, education, infrastructure and other social services continue to be ignored.


Wednesday, November 4, 2009

Lomborg Preaching to the Converted, Again

As we (Ribbon of Hope) go about, visiting our various clients in and around Nakuru, we see the many and fast changing problems that people here face. Some people get through these problems well enough, others don't. It's always hard to figure out if some make it through because they are better off than others or if they are better off because they are good at getting through problems or if there is a mixture of factors.

The rains have come in some areas. This means that it is time to plant crops. If the right preparations have been made, the crops should grow and if the rains continue, there will be a good harvest. But now the rains are here, are people preparing to harvest rainwater in order to ensure they get through the next drought? Sadly, not many people harvest rainwater. This doesn't appear to be a government priority either. The government even talked about distributing cheap or free seeds and fertilizer but now, there appears to be a shortage of both seeds and fertilizer because, well, er, the government has bought up so much of them. They must have just forgotten to distribute them.

In other areas, the rains have brought too much, too quickly, and have washed away fields, crops, roads, bridges, houses and anything else in their path. Were provisions made for flooding? It appears not. Roads that have been swept away in Coast Province were not flood proof. Floods occur with amazing regularity but flood proofing is an optional extra.

There have been power cuts again recently, despite promises that these would become a thing of the past. The government, it has been claimed, have now got the extra oil they need to make up for the shortfalls in power. Perhaps they will sort it out before the next fuel shortage. But fuel shortages, like floods, droughts, famines and other disasters keep occurring and will continue to occur. They need to be planned for. Last year, politicians were talking knowingly about planning for such disasters but there is little evidence that they have achieved anything yet.

The antics of the 'environmentalist' Bjorn Lomborg are well known to those who are interested in environmental issues but Nairobi appears to have the dubious pleasure of hosting a conference organised by Lomborg's 'think tank', the Copenhagen Consensus Centre.

Strangely enough, Lomborg appears to make a valid point about the need to concentrate on some very cheap, efficient and vital development programmes, such as micro-nutrient deficiencies and intestinal parasite infestations, which affect billions of people. However, there is a need to ensure that these billions of people have access to a balanced diet. The cheapest and most sustainable solution to these problems is not to enhance foods with various supplements and to produce things like vitamin A enriched chewing gum and other headline grabbing stories. There are already plenty of foods rich in vitamin A and other micro-nutrients. It's just that many people are too poor to afford them.

Lomborg also uses the opportunity given by this smokescreen to plug his tired old argument that climate change is not caused by human activities and that we need to adapt to it rather than trying to fight it. If the money and effort spent on denying that climate change is caused by human activities were to be spent on worthwhile causes, such as the ones Lomborg mentions, a lot of good work could have been achieved by now.

Kenya can't afford to risk accepting Lomborg's puny argument. Whether climate change is caused by human activities or not, the government has to put money into sustainable sources of energy for two reasons: first, these sources of energy will still be available for the foreseeable future, unlike fossil fuels; second, the country is not able to afford these expensive and unsustainable sources of energy and they are not able to afford the costs that go with high usage of unsustainable energy sources.

On the other hand, Kenya can afford to invest in wind power (as long as they produce their own generators, rather than buying the ridiculously expensive British ones that the UK government seems hell bent on selling them); they can afford hydrothermal power, solar power, biogas and probably all sorts of other ways of reducing the country's energy bill and the bill for the pollution and environmental damage that has taken place and that continues to take place.

But what is the government doing? Boasting about the possibility of finding oil in the Eastern Province. Billions have been sunk in drilling for oil in Kenya but the point is not that they have diddly squat to show for it. The point is that they don't need to spend all this money on fossil fuels when there are so many alternatives available here.

And the politicians will continue talking about flood proofing now the rains have come and they will surely talk about rainwater harvesting when the rains have gone away. If oil is discovered, they will rake in the money and when the oil has gone they will talk about how long term thinking is required. But I guess you can't blame Lomborg for talking the Kenyan government into stupid energy policies and development agenda. Because people who listen to such arguments seem to want to believe them.

And the bit that Lomborg gets right, that we could achieve a lot by working on micro-nutrient deficiencies and intestinal parasites, has long been recognised. But these are issues that the Kenyan government has little to say about.


Tuesday, November 3, 2009

Ribbon of Hope Self Help Group, Nakuru

Having come all the way to Nakuru to work for an NGO that turned out not to have any projects at present, I was lucky enough to end up working with some people who have a lot going on. Ribbon of Hope is a community based self help organisation. It was initially set up to work with HIV positive people but quickly evolved to support people who are in need of support for whatever reason.

Ribbon of Hope works with local self help groups, advising on and helping with relevant training, sources of finance, income generation schemes and ways of cutting household costs. Members of various local groups are engaged in producing food and other goods and services. Ribbon of Hope has raised the money to rent land and cover the costs of setting up a number of projects. They work closely with the local support groups, ensuring that everything is monitored and controlled adequately and they even go out into the fields to dig, plant and harvest crops.

At present, Ribbon of Hope is trying out new ways of making and saving money, such as solar cookers, fuel briquettes made from organic waste, homemade, reusable sanitary towels and various other techniques. The aim is to find things that are very cheap or completely free and that people with any level of education can avail of. Some people will only want to use the cookers, briquettes and sanitary towels. But others will want to learn how to make them and then sell them on to others.

In addition to these activities, people are involved in more traditional ways of making and saving money, such as growing maize and beans, rearing hens and cows and making jewellery and basketry products. In this way, people who work hard are more or less guaranteed some money, food or other goods. But the additional activities are intended to branch out from things that most self help groups are already doing, and to find some highly sustainable activities that have multiple benefits for those involved. Ribbon of Hope are researching and experimenting with anything that looks like it might help with their work.

It is important to find income generation and cost saving activities that are free or very low cost for two reasons: money is in short supply, pretty much everywhere; but, more importantly, many people in countries like Kenya realise that they need to become more self reliant. Many of the poorer people here have been depending on unsustainable sources of income and support for a long time. They are tired of having to go around to one NGO after another to take advantage of what usually turns out to be a short term hand out to tide them over from one crisis to the next. They don't see Ribbon of Hope as another source of handouts but as a way of getting away from handouts.

In the long term, the poorest people will need to find ways to raise their own living standards. They know that the huge amounts of aid money that come into the country usually end up in the pockets of those who are already well off, politicians, business people, churches and big NGOs. Kenyans have witnessed this over and over again and they don't expect it to change. All that the most active members of these local self help groups need is some initial assistance, in the form of small amounts of money and some good advice. They do the hard work themselves.

Sadly, there are people who are neither productive not supportive. Some are even outrightly destructive. So those who put a lot of work into improving their standard of living also need people to advocate for change, so that they can enjoy the fruits of their hard work. But as they become more self reliant and better able to avoid the effects of those who don't want them to succeed, they should also become better able to advocate for themselves. This function of advocating for and supporting self help groups is one of the most vital roles that Ribbon of Hope plays.

We are interested in hearing from other groups, especially community based groups, who are involved in low cost, sustainable projects that can be implemented regardless of levels of education or skills. In turn, we are happy to tell anyone who is interested about our experiences as we go along. I'll be documenting much of our day to day work on this blog but please feel free to get in touch if you have any questions.


Saturday, October 31, 2009

Reconsider the Proposed 'Census of Gay People'

Apparently Kenya is going to carry out a census of its gay population. People are expected to volunteer information about their own sexuality and the sexuality of others they believe to be gay. I certainly wouldn't volunteer information about my sexuality or that of others in Kenya. The issue of homosexuality is often met with a tight-lipped silence or a rabid stream of abuse.

The National Aids/STI Control Programme (NASCOP), which intends carrying out the census, claims that it is part of an effort to 'reach out' to the gay community. This may be so, but who will protect people's right to privacy when it comes to their sexuality? Will the police protect gay people or people suspected of being gay from persecution? This seems unlikely, given the police's reputation for being behind many kinds of persecution themselves. Police here are not known for their liberal views or even their love of peace and the rule of law.

All sexually active people should have access to HIV and other sexually transmitted infection (STI) testing facilities, condoms, sexual health education, counselling and other services. But they should also have the protection of the law and this is something that is not presently guaranteed. The way commercial sex workers (CSW), and those suspected of being CSWs or accused of being CSWs, are treated is a case in point.

NASCOP is worried that some people have the mistaken view that gay sex is safer than heterosexual sex, despite the fact that it is far more risky. But heterosexual anal sex is also mistakenly thought to be safer than vaginal sex. All sexually active people, and those who will soon become sexually active, need to know things like this. Men who have sex (MSM) with men may need additional services that other sexually active groups don't need. But groups who are at higher risk of contracting HIV and other STIs, such as MSM, CSWs and intravenous drug users, are all doing something currently against the law or considered to be against the law.

If the very act of trying to bring HIV and related services to gay people is also going to expose them to even greater dangers than they currently face, the whole idea of a 'census of gay people' should be reconsidered. It could be replaced by the provision of services to all people who require them, as and when. It may seem helpful to NASCOP to approach the gay population this way but there are too many flaws in getting people to identify themselves and others as gay in Kenya.


Wednesday, October 28, 2009

Prevention Needs to Consist of More than Good Intentions

To continue a theme that crops up regularly in this blog, an article on argues that Kenya needs to invest more in prevention campaigns than curative ones. True enough, but this article is about non-communicable conditions, such as hypertension, diabetes, mental illnesses, asthma and cancer. Health should start with prevention, whether that involves preventing communicable conditions, non-communicable conditions or even accidents such as road traffic accidents, industrial and agricultural accidents or injury and death from criminal acts.

However, realising that prevention is important is one thing, actually doing something about it is another. Take road traffic accidents (RTA), for example. All sorts of shenanigans have been put in place here recently, ostensibly to reduce RTAs. There are police checks and the rest, but what do the police do, exactly? Well, it's no mystery, they take a bribe and wave the driver on. There could be 22 people in a vehicle licensed for 14, bald tires, faulty brakes, out of date insurance or whatever, but as long as the police get their money, no further questions are asked.

In a country where health spending and health infrastructure has been reduced and continues to be reduced since the early 1980s, what exactly are health professionals supposed to do about all these conditions, communicable and non-communicable? The fact that prevention is better and cheaper than cure is irrelevant when there is bugger all money, anyway. But, even where prevention is even felt to be worth the effort, such as with HIV/Aids, are the figures for HIV transmission falling? Certainly not.

There is plenty of talk about preventing HIV but only 30% of HIV funding is allocated to HIV prevention. Most of that (which is probably nowhere near 30% of funding in reality) goes into a lot of mindless bullshit cobbled together by bigoted donors who don't give a damn about whether HIV transmission is really reduced as long as no one offends against their high minded but ultimately self serving interpretations of Christian morality. And it usually is Christian morality.

A report by a Nairobi based institution has come up with some alarming but unsurprising figures on teenagers knowledge of sex and their sexual behaviour. A large percentage of teenagers are having sex but they know little or nothing about safe sex. Unsurprising because they have been taught little or nothing about safe sex. Where has all the tens of millions of dollars intended for HIV prevention gone? It is has gone into not teaching teenagers about safe sex. I don't know how much money can be spent on the non achievement of something; that is in serious need of investigation. But the money is gone and the knowledge is nowhere to be found.

The report goes on to say that 40% of girls and 50% of boys have sex before the are 19, they believe all sorts of rubbish about sex, they fear pregnancy more than HIV, sex education is not taught in most schools, contraception is usually not mentioned (for fear of horrifying donors, politicians and church leaders, who are very sensitive people), half of the girls in a survey had exchanged sex for money, gifts or cash and 47% of the teenagers surveyed either had a child, were pregnant or had undergone an abortion. A separate study finds that 5.5 million girls between 15 and 19 give birth annually in Kenya, that's one eighth of the entire population!

If the calls for investment in preventing disease were to lead to improvements in very basic goods, such as water, sanitation and infrastructure, basic living conditions, primary health, education, gender equality, legal reform and things like that, Kenya would eventually be a lot better off. But it seems more likely that if any money is provided to prevent diseases and improve health, it will be spent on following purely political, commercial and religious agenda. Once those have been attended to, there's rarely any money left for anything else.